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Am I Qualified for FTM/FTN Top Surgery?
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For transmen and gender non-binary individuals seeking gender affirming top surgery, FTM (female-to-male) or FTN (female-to-non-binary) top surgery is often a crucial step in aligning their body with their gender identity. The procedure either involves the removal of virtually all of the breast tissue (mastectomy) or much of it (breast reduction) to either create a masculine or less feminine appearing chest.
The results are the alleviation of gender dysphoria and the improvement or disappearance of anxiety and depression. Importantly, these individuals can finally feel far more comfortable in their bodies.
However, not everyone who is seeking FTM or FTN top surgery is immediately eligible to undergo the procedure. There are several reasons for this which include the quality of care considerations, prudence and legal issues. These should be strictly adhered to before surgery is undertaken.
In the Standards of Care Version 8, published by the World Professional Association for Transgender Health (WPATH), the recommended criteria for gender affirming top surgery are listed. These are:
- Persistent, well-documented gender dysphoria
- Capacity to make a fully informed decision and to consent to treatment
- Age of majority in a given country (if younger, follow the SOC for children and adolescents)
- If significant medical or mental health concerns are present, they must be reasonably well controlled. Hormone therapy is not a prerequisite.
Do You Have Well-Documented Gender Dysphoria?
In order to be realistically considered for gender affirming top surgery, you should be experiencing gender dysphoria — a misalignment of your anatomy with your ideas of gender. For top surgery, this means that you hate, abhor or detest your breasts. They may not be emotionally part of you. They are a source of depression, anxiety, etc.
You should have a substantial period of experiencing gender dysphoria before considering surgery. It should not be a poorly thought out or rash decision made for some random reasons.
Additionally, you should have a thorough evaluation by a mental health professional who can definitively document this and ultimately write a letter listing this as a diagnosis.
Important in all this is that you want to minimize the risk of buyer’s remorse — regretting your decision to undergo gender affirming top surgery — and later seeking to detransition.
Can You Make a Fully Informed Decision and Consent to Top Surgery?
You must also be mentally and emotionally able to make a fully informed decision as to the choice that you are making, what is involved, the risks and complications as well the consequences and implications. This should be true of any surgery that you are considering.
A letter from your therapist needs to contain documentation of this.
Do You Meet the Age of Majority Requirement?
As of March 2025, the age of majority is 18 years old in 46 of the 50 states. In Alabama and Nebraska, it is 19 years old and in Maryland and Mississippi it is 21 years of age. Therefore, technically, you must be the listed age of majority in your particular state in order to be eligible for FTM or FTN top surgery.
That being said, due to a recent federal order, there appears to be a prohibition on the performance of any gender affirming surgery for those less than 19 years of age. This may or may not be temporary.
If You Have Medical or Mental Health Issues, Are They Well-Controlled?
You should be in reasonably good and stable physical and mental health for safety, healing and other reasons. For example, if you have hypertension, your blood pressure needs to be under control. If you have diabetes, your blood sugars should be reasonably well controlled.
The same goes for mental health issues. If you have anxiety, depression, schizophrenia, bipolar disorder, PTSD, etc. these need to be under control before undergoing surgery.
Other Considerations
The above are the crucial criteria that must be met prior to undergoing either FTM or FTN gender affirming top surgery. However, there are other relative factors that should be considered by you and/or your plastic surgeon.
Hormones
There are no requirements regarding taking hormones, whether for FTM or FTN top surgery.
Smoking
It is generally recommended to stop smoking cigarettes and marijuana as well as vaping for a period prior to surgery until some specified time following surgery. This period of time varies among plastic surgeons.
High BMI
A higher BMI is generally associated with higher anesthetic and surgical risks. This includes such issues as healing, wound separation, infection, failure of nipple graft healing and even blood clots. In addition, it is far more difficult, if not impossible at times, for accurate placement of the nipple grafts for individuals with a very high BMI.
Most plastic surgeons performing gender affirming top surgery will set BMI restrictions on the patients whom they will operate on.
Nutrition
Poor, inadequate or restricted nutrition and nutritional intake can lead to a higher risk for significant postoperative complications or less than desirable outcomes. Notable examples are vegans and vegetarians.
Compliance
It is crucial that you closely follow the recommendations provided by your plastic surgeon. This will help maximize the likelihood that you will obtain the results you desire and minimize untoward risks and outcomes.
If you won’t follow your plastic surgeon’s instructions — before or after surgery — it may be in your best interest not to undergo surgery. You will be setting yourself up for inferior results or failure.
Strong Support System
Having a good support system will help you get through the whole process far better — physically and emotionally. It may be family, friends or a spouse. They can definitely make your experiences easier and smoother if selected wisely.
Financial
There will be costs that you will be responsible for whether you are paying out of pocket or are covered under an insurance plan. Find out what all these expenses are and make sure that you are able to meet them before scheduling your surgery.
Realistic Expectations
You should have very clear and realistic expectations about the procedure and what it can and can’t accomplish. This not only includes the physical results but also the mental, emotional and social effects and impacts.
Scottsdale FTM/FTN Top Surgery Specialist
If you want to pursue FTM or FTN top surgery, consider scheduling a consultation with a plastic surgeon who is board-certified by the American Board of Plastic Surgery and who specializes in gender affirming top surgery.
Like Dr. Steven H. Turkeltaub.
Dr. Turkeltaub provides skilled and compassionate care for his patients in Phoenix, Scottsdale, across Arizona and beyond. Call us at (480) 451-3000 or complete our online contact form today to schedule your consultation.